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Fidelity Advisor IRA Distribution Request for Automatic Rollover Accounts, page 1

Basic · 45/100Form Complexity Index

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What this form asks for

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The Fidelity Advisor IRA Distribution Request for Automatic Rollover Accounts is an official Fidelity Investments form that allows account holders to request a full distribution from a Rollover IRA or Roth IRA that was automatically established on their behalf through an employer-sponsored retirement plan rollover. The form covers key details including account owner information, reason for distribution, distribution delivery instructions, and federal and state income tax withholding elections. Completing this form accurately is essential to ensure proper tax reporting and avoid potential penalties related to early withdrawals or missed minimum required distributions. Today, this form can be filled out quickly and accurately using AI-powered services like Instafill.ai, which can also convert non-fillable PDF versions into interactive fillable forms.

Fillable fields39

Pages4

Sections14

Form Complexity IndexBasic, 45/100

The AI checks your answers before you download

16 checks built for this form, so a wrong date or a missing answer is caught before anyone else sees it.

Social Security Number (SSN) Format and Completeness Validation

Validates that the SSN field (AC_SSN) contains exactly 9 numeric digits in the standard format (XXX-XX-XXXX or 9 consecutive digits). The SSN is required for IRS tax reporting purposes, as Fidelity must issue a Form 1099-R for the distribution. If the SSN is missing, incorrectly formatted, or does not match IRS records, federal income tax will be automatically withheld at the default 10% rate and the form cannot be processed.

Date of Birth Format and Age-Based Distribution Code Consistency

Validates that the Date of Birth (AC_DOB) is in MM/DD/YYYY format, represents a valid calendar date, and is logically consistent with the distribution reason code selected in Section 3 (RD_Distribution). For example, if the account owner's calculated age is 59½ or older, an Early Distribution code (Code 1 or J) should not be selected, and conversely, if the owner is under 59½, a Normal Distribution code (Code 7 or T) should not be selected. Mismatches between age and distribution code could result in incorrect IRS tax reporting and potential penalties for the account holder.

Required Account Information Fields Completeness Check

Validates that all fields marked as required in Section 1 are populated, including Account Owner First Name (AC_FirstName), Last Name (AC_LastName), SSN (AC_SSN), Existing Rollover IRA Account Number (AC_Account), Date of Birth (AC_DOB), Mobile Phone Number (AI_MobileNumber), and Email Address (AI_Email). The form explicitly states 'All fields are required' in Section 1, and missing any of these fields will prevent the form from being processed. Incomplete submissions will be returned to the account owner, delaying the distribution.

Email Address Format Validation

Validates that the Email Address field (AI_Email) contains a properly formatted email address following the standard pattern (e.g., [email protected]), is not left blank, and does not belong to an authorized agent or representative as explicitly prohibited by the form's instructions. The email address is required for electronic delivery consent verification, and Fidelity will send a confirmation message to this address to complete the consent process. An invalid or agent-owned email address will prevent the electronic delivery consent from being confirmed and may delay processing.

Mobile Phone Number Format Validation

Validates that the Mobile Phone Number (AI_MobileNumber) is entered in a valid U.S. phone number format containing exactly 10 digits (e.g., XXX-XXX-XXXX or (XXX) XXX-XXXX), with no letters or special characters other than standard formatting. The mobile number is designated as the primary contact and is used by Fidelity to verify and authorize transactions via call or text message. An incorrectly formatted or missing phone number will prevent transaction verification and block form processing.

Exactly One Distribution Reason Code Selected

Validates that one and only one distribution reason code is selected in Section 3 (RD_Distribution), and that the selection is appropriate for the account type (Rollover IRA vs. Roth IRA). The form provides separate sets of codes for Rollover IRA accounts (Codes 7, 1, 3, G) and Roth IRA accounts (Codes T, J), and selecting a code from the wrong account type or selecting multiple codes would result in incorrect IRS Form 1099-R reporting. Failure to select exactly one valid code will cause the form to be rejected or result in an incorrect tax filing.

And 10 more checks

Trustee Employer Plan Name Required When Code G Is Selected
Exactly One Distribution Method Selected in Section 4
Alternate Address Fields Completeness When Option B Is Selected
Overnight Delivery Eligibility Consistency Check
Federal Tax Withholding Election Completeness and Percentage Range Validation
State Tax Withholding Eligibility Based on State of Residence
Dollar Amount Provided for States Without Minimum Withholding Requirement
Signature and Date Presence and Format Validation
Printed Name Matches Account Owner Name in Section 1
IRA Account Number Format and Presence Validation

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How to Fill Out Fidelity Advisor IRA Distribution Request Online for Free in 2026

What the AI walks you through.

Navigate to Instafill.ai and upload the Fidelity Advisor IRA Distribution Request form or select it from the available form library.
Enter your account owner information in Section 1, including your first name, last name, Social Security Number, existing Rollover IRA account number, date of birth, mobile phone number, email address, and current mailing address.
Review and acknowledge the Electronic Delivery consent in Section 2, confirming your email address for receiving account-related communications electronically.
Select the appropriate reason for distribution in Section 3, such as Normal Distribution, Early Distribution, Disability, or Direct Rollover to an eligible retirement plan, and provide trustee information if applicable.
Choose your preferred distribution method in Section 4, indicating whether the check should be sent to your address of record, via overnight delivery, or to an alternate address.
Complete the federal and state income tax withholding elections in Section 5, specifying whether you want taxes withheld and at what percentage or dollar amount.
Review all entered information for accuracy, print your name, sign and date the form in Section 6, and submit the completed form to Fidelity via upload through Accounts.Fidelity.com, fax, or mail as instructed.

Common Mistakes in Completing Fidelity Advisor IRA Distribution Request

The ones the AI is built to catch.

Providing an incorrect or missing Rollover IRA account number

Many people cannot locate their Rollover IRA account number because it was automatically established by their former employer, and they may never have actively set it up themselves. Without the correct account number, Fidelity cannot process the distribution request. The account number can be found on the confirmation statement sent when the automatic rollover was established; if unavailable, account holders should call Fidelity at 800-248-4253 before submitting the form. Tools like Instafill.ai can help flag this field as incomplete before submission.

Selecting the wrong distribution reason code for age or situation

People frequently check the wrong distribution reason in Section 3, such as selecting 'Normal Distribution (Code 7)' when they are actually under 59½, or failing to select the 'Disability' option when applicable. Choosing the wrong code can result in incorrect IRS reporting, unexpected tax penalties, or the need to file additional forms like IRS Form 5329. Filers should carefully verify their age and circumstances against each option before checking a box, and consult a tax advisor if unsure which code applies to their situation.

Misunderstanding the 10% early withdrawal penalty for those under 59½

Many account holders under age 59½ are unaware that their distribution will be subject to a 10% early withdrawal penalty in addition to ordinary income tax, and they fail to account for this when planning their finances. This misunderstanding can lead to unexpected tax bills and underpayment penalties. The form clearly notes in Section A (Note 2) that IRS Form 5329 may need to be filed, but filers often overlook this requirement. Always consult a tax advisor before requesting a distribution if you are under 59½.

Failing to provide both a mobile phone number and email address

Section 1 explicitly states that both a mobile phone number and email address are required to verify and/or authorize transactions, yet many filers leave one or both fields blank. Without this information, Fidelity cannot send the electronic consent confirmation required in Section 2, which can delay or prevent processing of the distribution. Filers should ensure both fields are filled with current, accurate contact information they actively monitor. AI-powered form tools like Instafill.ai can flag these required fields as empty before the form is submitted.

Using a P.O. Box instead of a residential street address

The IRS requires a U.S. residential address for tax withholding purposes, and the Notice of Withholding explicitly states that a post office box does not qualify as a U.S. residential address. Submitting a P.O. Box may result in mandatory federal income tax withholding being applied regardless of the filer's election. Filers must provide a valid physical street address in Section 1 to ensure their withholding elections are honored. If the address on file needs to be updated, the checkbox in Section 1 must also be selected.

Incorrectly electing federal tax withholding or leaving it blank

Many filers either leave the federal tax withholding section blank or select a withholding rate without considering their total income and tax bracket, resulting in under- or over-withholding. If no box is checked, Fidelity defaults to withholding 10%, which may not be appropriate for the filer's tax situation. The form includes a W-4R Marginal Rate Table to help filers calculate the correct withholding rate based on their filing status and total income. Filers should review the 2025 Marginal Rate Tables provided with the form and consult a tax advisor to select the most appropriate rate.

Ignoring state-specific tax withholding rules

State tax withholding requirements vary significantly — some states mandate withholding, some allow voluntary withholding, and others do not permit it at all. Filers often apply a one-size-fits-all approach, either electing state withholding when their state doesn't allow it or failing to elect it when it is mandatory (e.g., residents of CT, MI, MN, or OK). Failing to comply with state-specific rules can result in underpayment penalties at the state level. Filers should carefully review the State Tax Withholding matrix in the Notice of Withholding to determine the rules for their specific state of residence.

Attempting to use this form for an IRA transfer instead of a distribution

Some account holders mistakenly use this Distribution Request form when they actually want to transfer their IRA assets to another institution, which is a fundamentally different transaction. Note 4 in Section A explicitly states that this form should NOT be used for transfers, and that the receiving institution must provide a letter of acceptance to FIIOC. Using the wrong form for a transfer can cause delays, unintended tax consequences, or the distribution being processed as a taxable withdrawal. Filers who want to transfer assets should contact the receiving institution directly for their specific transfer requirements.

Not understanding Roth IRA qualified distribution requirements before requesting a distribution

Roth IRA account holders frequently request distributions without verifying whether they meet the 5-year aging period requirement and the age/disability criteria needed for a qualified, tax-free distribution. If these requirements are not met, the distribution may be subject to income tax and a 10% early withdrawal penalty, which can be a costly surprise. Note 5 in Section A provides detailed guidance on the 5-year rule, including how rollover contributions are treated. Filers should consult a tax advisor to confirm whether their Roth IRA distribution qualifies before submitting this form.

Selecting overnight delivery without meeting the eligibility requirement

Some filers check the overnight delivery option in Section 4 without realizing it is only available when the address in Section 1 is the existing address of record (i.e., the 'Update address' checkbox must be unchecked). If a new address is being provided, the check will automatically be sent via regular mail regardless of the overnight selection, and the $20 fee may still apply. Filers who need expedited delivery should ensure they are not simultaneously updating their address on the form. Reading the asterisked note next to the overnight option carefully can prevent this confusion.

Entering the date of birth in the wrong format

The form requires the date of birth in MM DD YYYY format, but filers commonly enter it in other formats such as MM/DD/YY, YYYY-MM-DD, or with slashes and dashes in the wrong places. An incorrectly formatted date of birth can cause processing errors or delays, and may affect the determination of which distribution code applies (e.g., whether the filer is over or under 59½). Filers should double-check that they are using the exact MM DD YYYY format as specified. AI-powered tools like Instafill.ai can automatically format date fields correctly to prevent this type of error.

Forgetting to sign and date the form or printing the name incorrectly

Section 6 explicitly states the form cannot be processed without a signature and date, yet many filers submit the form without completing this section, causing significant processing delays. Additionally, the form requires the account owner's name to be printed in First, M.I., Last order in a separate field above the signature line, which is often skipped. The date must also be entered in MM-DD-YYYY format. Filers should review the entire form before submission to ensure Section 6 is fully completed, and use Instafill.ai to catch missing required fields like signatures and dates before finalizing.

Frequently Asked Questions About Fidelity Advisor IRA Distribution Request

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How does the AI fill out Fidelity Advisor IRA Distribution Request?

You answer a few questions in plain words, or upload a document you already have. The AI reads what you give it and puts each answer into the right field of Fidelity Advisor IRA Distribution Request, on every page, in seconds. It checks the answers against the form's own rules, and you review and change anything before you download, print or sign.

What happens to my information?

It is encrypted in transit and at rest, and it is never used to train AI.

How complex is Fidelity Advisor IRA Distribution Request to fill out?

Fidelity Advisor IRA Distribution Request has a Form Complexity Index of 45 out of 100, in the basic tier: 39 fillable fields across 4 pages. Instafill.ai's AI fills it in under a minute, with every field there for you to review before you download.

What is the purpose of the Fidelity Advisor IRA Distribution Request form for Automatic Rollover Accounts?

This form is used to authorize a full distribution of your Fidelity Advisor Rollover IRA or Roth IRA that was automatically established by your former employer on your behalf through the rollover of assets from your former employer's retirement savings plan. It allows you to request a complete liquidation of that account.

Who needs to fill out this form?

This form is for individuals who have a Fidelity Advisor Rollover IRA or Roth IRA that was automatically set up by a former employer when they left that job. If you want to take a full distribution from that automatically established account, you must complete this form.

What information do I need to complete Section 1 (Account Information)?

You will need to provide your full name, Social Security Number (SSN), existing Rollover IRA account number, date of birth, mobile phone number, email address, and current street address. All fields in this section are required. Your account number can be found on the confirmation statement from your automatic rollover, or you can call Fidelity at 800-248-4253 if you cannot locate it.

What happens if I am under 59½ and take a distribution?

If you are under 59½, your withdrawal is generally subject to a 10% early withdrawal penalty in addition to ordinary income taxes. You may also be required to file IRS Form 5329. If you plan to roll over the distribution within 60 days, Fidelity is still required to report the withdrawal to the IRS on Form 1099-R as an Early Distribution (Code 1 or J).

What are the distribution reason codes and which one should I select?

For a Rollover IRA, you can choose: Code 7 (Normal Distribution, age 59½ or older), Code 1 (Early Distribution, under 59½, no known exception), Code 3 (Disability, under 59½), or Code G (Direct rollover to an eligible employer retirement plan). For a Roth IRA, choose Code T (age 59½ or older or disabled) or Code J (Early Distribution, under 59½). Select the code that matches your current situation.

Can I transfer my IRA to another institution using this form?

No, this form should not be used for transfers to another institution. If you want to transfer assets from your Fidelity Advisor Rollover IRA or Roth IRA to an IRA at another institution, you should contact that institution directly for their requirements. Fidelity (FIIOC) will need to receive a letter of acceptance from the receiving institution to complete the transfer.

How do federal income tax withholding elections work on this form?

The default federal withholding rate is 10% of the gross distribution (excluding Roth IRAs). You can elect NOT to have federal taxes withheld, or you can choose a different rate between 1% and 100%. If you make no election, Fidelity will automatically withhold 10%. Note that for payments delivered outside the United States, you generally cannot choose less than 10%.

How does state income tax withholding work, and does it vary by state?

State tax withholding rules vary significantly by state. Some states (like AK, FL, TX, and others) do not allow state tax withholding at all. Some states have voluntary withholding, while others (like CA, MA, MN, and others) have mandatory minimum withholding rates. Refer to the Notice of Withholding included with the form or consult your tax advisor for your specific state's requirements.

What are the rules for qualified distributions from a Roth IRA?

A Roth IRA distribution is considered qualified if the 5-year aging period requirement is satisfied AND you are age 59½ or older, or disabled as defined by the IRS. The 5-year period begins on January 1 of the first year you made a contribution to any Roth IRA. If you do not meet these requirements, your distribution may be subject to income tax and a 10% early withdrawal penalty.

How can I submit the completed form to Fidelity?

You can submit the form in three ways: upload it online by logging into Accounts.Fidelity.com and using the 'Upload Documents' link under 'Manage Accounts'; send it by fax to 888-321-7349; or mail it to Fidelity Investments Institutional Operations Company LLC, P.O. Box 770002, Cincinnati, OH 45277-0082 (or use the overnight address: 100 Crosby Parkway, KC1G, Covington, KY 41015). Note that if an original signature guarantee or notary is required, the form must be mailed.

Can I receive my distribution check at an address other than my address of record?

Yes, Section 4 allows you to choose to have the check sent to an alternate address. You can also request overnight delivery of your check for a $20 fee, but overnight delivery is only available if you are not updating your address in Section 1. If you are sending the check to a new address, it will be sent via regular mail.

What is the minimum required distribution (MRD) rule for Rollover IRAs?

Under IRS rules, you must begin receiving minimum required distributions from your Rollover IRA by April 1 following the calendar year in which you turn 73. Failure to take the required distribution could result in substantial penalties. Contact your tax advisor or local IRS office for details on calculating your MRD.

Can I use AI tools like Instafill.ai to help fill out this form?

Yes, AI-powered services like Instafill.ai can help you accurately auto-fill the form fields, saving you time and reducing errors. If you have a flat, non-fillable PDF version of this form, Instafill.ai can also convert it into an interactive fillable form so you can complete it digitally.

How do I fill out this form online using Instafill.ai?

To fill out this form online, visit Instafill.ai and upload the Fidelity Advisor IRA Distribution Request PDF. The AI will guide you through each field—such as your account information, distribution reason, and tax withholding elections—auto-filling where possible. Once complete, you can download the filled form and submit it to Fidelity via upload, fax, or mail.

What should I do if I have questions or need help completing the form?

For assistance, you can contact your Financial Representative or call Fidelity's Retirement Specialists at 800-522-7297, available any day the New York Stock Exchange is open. If you cannot locate your account number, call 800-248-4253. You may also consult a tax advisor for questions about withholding, penalties, or Roth IRA qualification rules.

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